TB and primary health – a vignette from Vrindavan

I call this a vignette because it is an impressionistic piece. My claims are not backed by data because I could not find them. The contents of this post are derived mainly from conversations which I have no reason to disbelieve. Why Vrindavan? That’s simply because I have a job that involves travel and Vrindavan is one of the places I went to recently. I intend to collect these vignettes from each place I go to.

At the end of a three hour drive, around 150 kms away from New Delhi, is Vrindavan, one of India’s most famous and hallowed pilgrimage towns. The town is dotted with hundreds of little and big temples devoted to the Lord Krishna and Radha.

Vrindavan is actually a little more than a village with dusty lanes and open drains and houses set close to one another. Parts of it are rapidly developing what with scores of real estate developers having descended on the place. So you find modern buildings nestling cheek by jowl with old dilapidated dwellings.

Bright lights and loud devotional music assault the eyes and ears while driving through the main road of Vrindavan in the evening. Devotees who have come to visit Vrindavan bustle about happily shopping for souvenirs and the beautiful jewelled pictures of Radha and Krishna that adorn the shop shelves.

Amidst all this, it is difficult to find a clinic. Where do the locals go for their ailments one wonders. A few enquiries reveal that there are indeed a few clinics in the town. One is strangely sharing space with what looks like a TV repair shop. The doctor in the clinic is more than willing to talk when I go in and ask whether he can talk to me about TB. He says he also works at the local Ramakrishna Mission Hospital. In the evenings he sees patients at his clinic. And he reveals some startling facts that make me gulp.

He says he sees 60-80 patients a day and more than 50 per cent of them are suffering from TB. They come to him from villages around Vrindavan and could have sometimes travelled around 20 kms just to reach the hospital or his clinic. What is even more startling is his statement that most of them come to him after complications have set in. He is more than certain that they have first seen a local physician or quack in their villages, have been treated for TB on suspicion alone and have dropped out of treatment as soon as they began to feel better. He cannot say for sure whether they qualify as MDR TB cases but has a suspicion they could. When asked about testing facilities, he says that he refers them to the local DOTS centre where standard testing facilities are available. But he also says that some of these patients have already been scared into undergoing expensive and ineffective tests by some private practitioners; this has burnt huge holes in their pockets and they are in debt.

A little distance away is a little clinic that has a bed and a forlorn drip bottle suspended above it, indicating that the clinic also doubles up as a ‘hospital’ of sorts. Near the entrance, surrounded by dusty bottles and potions, sits the registered medical practitioner who says that he does not know how to diagnose TB and only administers treatment for primary illnesses such as cold, cough, fevers etc. My question about whether any of these cases could actually be TB does not find favour with him and he indicates he does not want to take any more questions by pointedly talking to a lady who has come in after me. After waiting for some time, I leave, taking the cue. I am told there are two or three more clinics in the town and go in search of them. Despite walking through the badly lit interior alleys in the town, I am unable to find them.

Before the reader begins to wonder what I’m trying to say, let me hasten to clarify. I don’t have answers. Only questions. Where does a patient go when he or she is sick with cold, cough and/or fever? Does the person go immediately to the nearest DOTS centre? The question precludes an answer. It is obvious that the first point of care is the general physician or the registered medical practitioner. Does that not make TB primarily a primary health problem? What hope does the person have if the doctor is not alert enough to pick up symptoms and seek referral help? What does it take for each local DOTS centre to sensitise the local doctors, (who are very often also very popular among the locals) to the problem and encourage them to be alert to possible cases of TB? We have the figures, we have the evidence and we absolutely know we have a problem. What does it take to aggressively take it on and solve it? The questions beg answers.